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FEB 2`01990 MOK-a -42 ucta 4 <br />DR -462 <br />Revised 12/78 <br />(Sec. 155.106, F.S.) <br />REFUND APPIROVED <br />DATE NOV 2 71979 - <br />> J <br />PARTME d OF EVEN E <br />REQUISITION FOR REFUND OF AD VALOREM TAXI' -"S <br />STATE OF FLORIDA <br />CO 1. N T Y O F —gi ant Aj US -r <br />Pursuant to Section 195.106, Florida Statutes, <br />--Crayps RrnK.—Co. Of - P. 0. Box 277 L. Wabasso, Florida <br />(Payee) (Residence) <br />lerrin males application fo the Department of Revenue for refund of $ �1.4� <br />(AnIonnt) <br />of "'(meds paid to the Comity Tax Collector and as gronads therefor sets clh the following farts: <br />(State reason for Refund) <br />County Property Appraiser reduced the Classified Use Value from $35,500. <br />to $31,990., thereby reducing the amount of the 1973 taxes. <br />:Attached he icto is additional proof to establish such claim, as follows: <br />Photo of 1978 Tax Receipt validated in the amount of $606.45 <br />Photo of Certificate of Correction of Tax Roll #5- 30755 <br />Sworn and subscribed to <br />before Inn tllis da", <br />of%r.: Icy{ 19 <br />1► f � fl <br />Notary hiblic <br />S:ate Cf F(rric? <br />� ct Lrr;e <br />:r" lune 5. 1;53 <br />GRAVES BROS. Co. <br />BY: <br />(I'aree) <br />